Oral rehydration in infantile diarrhoea.

Sir, In their review of acquired toxoplasmosis in children, McNicholl and Flynn (Archives, 1978, 53, 414) suggest the use of sulphadimidine and pyrimethamine for treatment of generalised toxoplasmosis. We report a child with generalised toxoplasmosis who had a dramatic recovery after treatment with co-trimoxazole. An 1 1i-year-old girl presented to the hospital with an 8-week history of weight loss, fever, malaise, lymphadenopathy, and intermittent muscle pain. There were several cats and dogs in the home. On admission there was pronounced weight loss, generalised lymphadenopathy, erythema nodosum, and muscle tenderness in both quadriceps. On investigation the significant finding was a toxoplasmosis antibody dye test titre of 1: 4096. A lymph node biopsy showed histological appearances consistent with toxoplasmosis. As the patient remained unwell 2 weeks after admission she was given a onemonth course of co-trimoxazole (400 mg sulphamethoxazole and 80 mg trimethoprim twice daily). A week later her myositis had resolved, the lymphadenopathy decreased, her appetite returned and she was more active and felt better. After one month's treatment her weight had increased by 2.35 kg and there were no residual signs or symptoms. A combination of sulphadimidine with pyrimethamine is generally recommended for the treatment of acquired toxoplasmosis, but pyrimethamine can have significant side effects. Co-trimoxazole has been used for 1 to 3 months in the treatment of acquired and congenital toxoplasmosis with encouraging results (M6ssner and Auwairter, 1972; Domart et al., 1973; Norrby et al., 1975). As co-trimoxazole is significantly less toxic than pyrimethamine we suggest that it should be the first choice of treatment in toxoplasmosis.